Exam 1 Flashcards
(152 cards)
1
Q
What ratio of pediatric patients will develop amblyopia?
A
1/30
2
Q
What ratio of pediatric patients will develop strabismus
A
1/25
3
Q
What ratio of pediatric patients will show a significant refractive error?
A
1/33
4
Q
What ratio of pediatric patients will show eye disease?
A
1/100
5
Q
How commonly does a vision disorder cause disability in the United States?
A
4th most common!
6
Q
What is the most common handicapping condition of childhood?
A
Visual problems
7
Q
What percent of children aged 9-15 need glasses? Of this percentage, how many of those children have glasses?
A
20% need glasses
10% of the 20% have them
8
Q
How likely are pediatric patients to have had a comprehensive eye exam by age 6? 6-16?
A
By age 6: 14%
Ages 6-16: 31%
9
Q
Explain how common vision screenings are by pediatricians. What is a pediatrician’s vision screening?
A
66% of pediatricians do vision screenings
A vision screening is: “When 10 seconds are taken to evaluate a patient’s vision by trying to get the patient to cooperate”
10
Q
How common is it for a patient to fail a vision screening and have the parents unaware?
A
50% of children who have failed a vision screening have parents who are unaware 2 months later!
11
Q
What are some of the primary benefits of pediatric eye exams? What are some secondary benefits?
A
Primary Benefits:
- Early detection and treatment of amblyopia
- Early detection and treatment of strabismus
- Early detection of significant disease
Secondary:
- Looks good for our profession, more recognition of contribution to public health
- Importance of vision in normal development can be stressed
12
Q
What are the different stages of pediatric patients?
A
Premie: Less than 37 weeks. Neonate: 0-28 days Infant: 29 days - 11 months Toddler: 1 - 3 years Child: 3- 13 years Adolescent: 10-19 years
13
Q
Explain adjusted age with premies.
A
Premies are born at less than 37 weeks and this can affect developmental milestones. Adjusted age is calculated by determining the time between birth and the due date to appropriately scale developmental milestones
14
Q
What are the AOA frequencies of examination for different age groups?
A
A = Asymptomatic R = At risk
Birth-24 months:
A: 6 months
R: 6 months/as recommended
2-5:
A: 3 years
R: 3 years/as recommended
6-18:
A Before 1st grade, then every 2 years
R: Annually/as recommended
18-60:
A: Every 2 years
R: Every 1-2 years/as recommended
61+:
A: Annually
R: Annually/as rec
15
Q
What are some purposes of an infant eye exam?
A
- Optimize visual function that is important for the development of the infant
Determine if the eyes are straight, healthy, and can the baby see? Do you need to intervene to:
a) improve vision
b) prevent/treat an eye turn
c) prevent amblyopia
d) prevent/treat an ocular health issue
16
Q
When is the best time for a pediatric eye exam?
A
The best time is in the morning or after a nap. Patients will not be as well behaved if the appointment is during the scheduled nap time!
17
Q
How do you navigate an infant eye exam?
A
Base your judgment and prescribing on observation, reflexes and gauge your expectations. Don’t expect perfect vision, just make sure basic functions are present
18
Q
What is the assessment protocol for pediatric eye exams?
A
- VA:
Fix and follow
Richman Face Paddles
Vertical Prism - RE:
Mohindra
Cyclo
3. BV: CT Vertical Prism Bruckner Hirschberg
- Motility:
EOM
5. Health: Visual field Pupils Gross external Dilated internal
19
Q
What are some important questions to ask regarding case history for infant eye exams? (6)
A
Normal developmental milestones met?
Full-term pregnancy? (less than 37 weeks is preterm)
Normal birth weight?
Problems during pregnancy/delivery?
Medical issues?
Any current therapies or medical interventions?
20
Q
When are three important ages that the average pediatric patient should have an eye exam?
A
Before age 1
At age 3
Before 1st grade
21
Q
What percent of pediatric patients have never had an eye exam?
A
70%!
22
Q
What is a good range of RE for an infant?
A
Plane - +4.00D
23
Q
What are the two main objectives for VA’s in pediatric patients?
A
Quantitative: What is the acuity threshold? OD? OS? OU?
Qualitative: Are they adapting, using both eyes?
24
Q
What are 3 ways to perform VA on pediatric patients?
A
Fix and follow
Resistance to occlusion (Will get fussy if having to use “bad” eye)
Vertical prism (Eyes will jump between if using both eyes)
25
What are three ways you can quantify VA on pediatric patients?
1. Detection acuity with Cardiff cards
2. Resolution with lea paddles or teller paddles
3. Recognition by naming/matching
26
What age/situations would preferential looking be optimal for?
0-12 months or developmentally delayed.
The child will look at black/white lines instead of grey. You continue to decrease contrast until the child alternates fixation (cannot see grating anymore)
27
What is the VEP?
Visually Evoked Potential
| Measures electrophysiological response to light. This is more reliable than preferential looking but is more expensive
28
What is the difference between static and dynamic ret?
Static occurs when fixation is at optical infinity and is relaxed
Dynamic involves near accommodative abilities
29
Explain the Mohindra Technique.
Near ret performed in a dark room at 50cm. If performed monocularly, subtract 1.25D from neutralizing lens. If performed binocularly, subtract 0.75 - 1.0 D from neutralizing lens
30
Autorefraction has minimal value without ___________.
cycloplegia
31
What are the expected results for Hirschberg?
Equal reflexes that are ~+1.00mm nasal
| 1mm = 20^
32
What are some rules of thumb for birth weight in children?
Should double by 5 months
Should triple in 1 year
Should quadruple in 1.5 years
33
What is the rule of thumb for the length of a newborn?
Should increase 1.5x in 1 year
34
What are the body structure proportions as a person develops from birth to adolescence?
```
Head should increase 2x
(Head contributes 1/4 of birthweight, 1/12 of weight at maturity)
Trunk should increase 3x
Upper extremities should increase 4x
Lower extremities should increase 5x
```
35
What are tissue proportions as a person develops from a newborn to an adult?
Muscle:
Neonate -> 20%
Adult ->45%
Internal Organs:
Neonate -> 15%
Adult -> 10%
Nervous System:
Neonate -> 15%
Adult -> 3%
36
What point in embryological development is the eye discernable? When are structures identifiable?
The eye is discernable in 3 weeks
| Structures are identifiable by 5 weeks
37
What are the two goals of eye development?
Create a transparent optical system
| Develop neural transmission of information
38
What is the master control gene for eye formation?
Pax-6
39
What occurs in the embryonic period? When is the embryonic period?
1. Mesoderm surrounds the optic vesicle (day 26)
2. Mesenchyme fills the optic cup with vitreous and supplies early posterior chamber with blood supply
3. The early hyaloid system is formed by the end of the second month
Embryonic period is Up to 9 weeks
40
When is the fetal period?
Fetal period is 9 weeks of gestation (63 days) to birth
41
Abnormalities in the fetal period result in _______ abnormalities whereas abnormalities in the embryonic period result in _______ abnormalities.
Fetal: functional problems
Embryonic: Structural
42
What occurs before the eyes open in the gestational period?
Retinal structures have differentiated and formed. Axons connecting retinal to LGN to cortex have connected
43
When do axons enter the LGN from the optic tract?
7-8 weeks
44
What is Hebb's Law?
Neurons that fire together wire together
45
Explain LGN formation and the probability of vision problems.
If LGN is formed and then there is a problem, likely there will be a significantly lower risk of vision problems occurring. If a problem is before LGN forms, there is a higher chance of vision problems.
46
When are the visual cortex cells developing?
6 weeks to 5 months
47
Which layer of the cortex is formed first in development?
Innermost layer
48
When do axons from the LGN reach the cortex?
11-13 weeks
49
When are synapses made into the cortical plate?
23-25 weeks
50
When do ocular dominance columns arise?
AFTER the eye is open
51
Structural abnormalities are due to insult in the _______ period and functional abnormalities are due to insult in the ________ period. (REPEAT CARD)
Structural: Embryonic
Functional: Fetal
52
What are the three phases of axial length?
0-2 years: 4mm in year 1 and 2mm in year 2
2-5years: 1mm
5-13 years: 1mm
53
What is the power of the cornea at birth and what is the power at 6 months? What is the corneal power at 12 months?
Birth: 52D
6 Months: 46D
12 Months: 42-44D
54
What is the diameter of the cornea at birth? As an adult?
Birth: 10mm, +/- 0.5mm
Adult: 12mm
55
When does OKN become apparent? (Pursuits/Saccades)
34 weeks
56
Which gaze, horizontal or vertical is established at birth? Which takes 6 months?
Birth: Horizontal
| 6 Months: Vertical
57
When do Accommodation and NPC develop?
3 months
58
When are melanin deposits evident on the iris?
6-12 months
59
When is the pupil reactive?
31 weeks (2 months before birth)
60
What is a normal pupil size in an infant -> 2-year-old?
5mm
61
What is the typical IOP measurement in infants? What about in school-age children?
Infant: 10-12mmHg
| School-age: 14mmHg
62
When are cones differentiated?
4 years after birth
63
When does myelination of the optic tract finish?
2 years after birth
64
When does a patient first have normal acuity (~20/20)
6-7 months old
65
Is optokinetic nystagmus normal in infants?
yes
66
In what situations will an infant have OKN regardless of the direction that the drum spins?
Binocular situations and monocular situations when the infant is 3 months or older
67
In what situations will an infant have OKN in temporal to nasal direction but NOT nasal to temporal direction?
Monocular situations when aged 1-2 months
68
What does an asymmetric OKN response in children indicate?
Abnormal binocularity. This may be strabismus or amblyopia!
69
When do infants develop stereopsis?
6 months
70
What is the typical timetable for color vision development? When does color vision reach near-adult levels?
1 month: Improved blue/green vs gray
3 month: red/yellow/green/blue vs gray
Confirmed with preferential looking
Adult like levels of color vision occur around 3-4 months but the threshold is much higher (lower sensitivity)
VEP says the color threshold is adult-like in early teenage years
71
What are some causes of disrupted development? Name 3-4.
```
Nutrition
Teratogens
Trauma
Prematurity
Genetics
Hypoxia
Fever
Infection
Sensory Deprivation
Sleep Deprivation
```
72
How might the malnutrition of the mother impact development?
The mother must be severely malnourished for there to be an impact. One example is once the fetus is pulling calcium from the bones. If this occurs there will likely be a low birth weight
73
What are 3important nutrients that are essential for normal development?
Folic Acid: Prevents Spina Bifida
Iodine: Deficits cause slow growth/impaired neural dev
Omega 3's: Promote vision and brain development
74
How does type II diabetes impact pregnancy?
Parents are are type II must take insulin to control diabetes while pregnant to prevent drug issues.
75
What are some teratogen examples that can impact fetal development?
Lead
PFC
Phthalates (food packaging/makes plastic soft) CAUSE SPEECH DELAYS
76
What are three examples of trauma that may cause fetal/child developmental problems?
Birth trauma
Immature vasculature (cerebral palsy)
Acute accidents (TBI) -> Learning disabilities
Chronic subclinical concussion (soccer/football hits)
77
What are some examples of the impact of prematurity on growth and development?
Prematurity can cause a low birth weight. If vasculature is not fully developed, vessels can break during the birthing process and cause injury.
78
What are 3 genetic conditions that can impact development?
Down Syndrome
Fragile X
Turner Syndrome
79
How does excess TV/Video games impact development?
It can cause sensory deprivation. Patients who are less than 2 years of age should have minimal media exposure. Ages 2-5 should be limited to 1 hour of media per day. GET OUTSIDE AND PLAY
80
What supplement can you give an 8-10-year-old to improve academic performance?
Lutein
81
What level of fever can cause brain trauma?
107.6F+
82
What is a low birth weight by definition?
What is a very low birth weight by definition?
What is an extremely low birth weight by definition?
Low Birth Weight: <2,500g (5lb 8oz)
Very Low Birth Weight: <1,500g (3lb 5oz)
Extremely low birth weight: <1,000g (2lb 3oz)
83
When should a child sit unsupported?
8 months
84
When should a child walk with support?
9 months
85
When should a child climb stairs?
12 months
86
When should a child walk unsupported?
15 months
87
When should a child walk up stairs?
24 months
88
When should a child alternate feet while walking up stairs?
36 months
89
When should a child say double syllables?
9 months
90
When should a child say two words?
12 months
91
When should a child say a 3-word sentence?
24 months
92
When should a child know rhymes?
36 months
93
When should a child be able to count to 10?
60 months
94
When should a child know colors and ABC's?
60 months
95
What are the two main factors of emmetropization?
Genetics: Growth: Nature
Environment: Maturation: Nurture
96
What is considered the passive process of emmetropization?
The natural growth of the body and development of the eye.
Axial length increases
Cornea flattens
Etc
97
What are 3 general trends of newborns?
1. Hyperopia is more common, 88% between plano and +4.00D (average is +2.00D)
2. Astigmatism is common and goes away in a couple of years
3. Anisometropia is not common
98
What is active emmetropization influenced by?
Blur
99
At what age(s) does active emmetropization have the greatest effect?
First two years of life
100
What is the mean refractive error by age 5-6 (school age)?
+1.00D +/-1.00D
101
Children at age 6 with RE of _____ were at high risk for significant myopia by 6th grade.
102
Which groups have less hyperopia? Which groups have more astigmatism?
Less hyperopia: Asians
| More astigmatism: Hispanic/African American
103
Which patients (RE + Posture) have more risk of myopia progression?
Low myopes with eso posture
104
Which age group has the lowest prevalence of myopia?
5-7-year-olds (1-2%)
105
What is a protective factor for myopia progression? What is a negative factor for myopia progression?
Protective: Outdoor time
Negative: Device time
106
What RE has the highest prevalence?
Hyperopia
107
What are 3 conditions associated with high hyperopia?
Microphthalmia
Optic atrophy
Fragile X
108
How does hyperopia vary with age?
Increased from 3-6 years by 1D
Decreased from 7-puberty by less than 1D
Congenital high hyperopia does NOT tend to progress
109
At what amount of hyperopia should parents be informed the child will remain hyperopic?
1.50D+ in 5-6-year-old
110
During what age does astigmatism have the highest incidence?
first year
111
How much astigmatism might a child have at 6 months? 18 months? 24 months? How does this affect treatment?
6 months: 2-2.5D
18 months: 1D
24 months <0.50D
Wait for astigmatism to stabilize before you treat
112
When do you need to start treating astigmatism if it significant?
2 years of age
113
How should you treat hyperopia in kids?
Prescribe for optimal BV function, you don't want a hyperope to develop strabismus or amblyopia, but you don't want to impair emmetropization. Better to have a patient be hyperopic than eso or amblyopic!
114
What is 3x3 rule?
3 visits over at least a 3-month span
115
What are some complications of uncorrected hyperopia?
>2.00D risk increases for strabismus, amblyopia, and learning difficulties
116
What is a likely cause of anisometropia?
BV issues, fix the BV issue, fix the anisometropia
117
What is the single highest risk factor for developing amblyopia?
Anisometropia
118
Is anisometropia more problematic for myopes or hyperopes?
Hyperopes
119
What is the main goal when treating anisometropia?
Equal BV like lag/amps in each eye
120
Which type of astigmatism (WTR/ATR/OBL) is most important to correct? Least?
Most: OBL
Least: WTR
121
In a preschooler, myopia that is greater than _____D should be corrected.
3.00D
122
When should you first start fully correcting myopia in children?
Kindergarten age
123
What are 3 ways to combat and slow myopia progression?
Atropine
VT
CL
124
How does VT slow myopic progression? (3)
Improves binocularity
Improves accommodation
Improves peripheral awareness
125
Where should you position a bifocal on a child?
Top of the segment to bisect pupil to encourage the use of bifocal
126
Define the following terms.
Growth:
Differentiation:
Maturation:
Growth: Proliferation
Differentiation: Increased complexity
Maturation: Repeated experience and purposeful use
127
What is the timing of fundamental skill development and then refinement?
Fundamental: 0-6 years
Refinement: 6-12 years
128
What is the most important hormone in childhood?
Pituitary hormone. It reduces the deposition of fat and causes protein to be laid down for growth
129
What directions does a person grow?
Head to foot (cephalocaudal)
| Center to periphery (Proximodistal)
130
What are the steps in motor development?
```
1. Posture control:
Balance
2. Locomotion: Moving through the spatial environment
Walk/Run
3. Contact: Manipulating objects
Grasp/Hand to hand
4. Receipt and Propulsion: Purposeful intersection with a moving object and imparting movement to an object
Catch and throw
```
131
```
What is the timeline for the following gross motor milestones?
Head control:
Roll Over:
Sitting:
Walking:
Kicking ball:
```
```
Head Control: 3 months
Roll Over: 4-5 months
Sitting: 5-8 months
Walking: 12 months
Kicking ball: 15 months
```
132
What is the timeline for the following fine motor milestones?
Grasp: Voluntary let go
Grasp: Pincer and purposeful release
Hand dominance:
Grasp: Voluntary let go: 8 months
Grasp: Pincer and purposeful release: 12 months
Hand dominance: 12 months
133
When do girls have their growth spurt? Boys?
Girls: 9.5-14.5 years
Boys: 11-18 years
134
Are girls superior in gross or fine motor? What about boys?
Girls are superior in fine motor
| Boys are superior in gross motor
135
What are some factors that affect motor development? (5)
```
Gender
Socio-economic status
Health/Disease
Accidents and Injuries
Physical impairment
```
136
Is TV associated with activity levels in children?
No, but access to facilities and/or opportunities to play (like parks) is related to less activity
137
What ratio of people in the US is hungry?
1/8
138
How does poverty impact nutrition?
Poverty-stricken families buy less nutritious food, so kids aren't eating less, they are eating normal amounts of POOR foods, which contributes to obesity
139
What are the key nutrients for kids? (4)
Vitamin D
Vitamin A
Iodine
Iron
140
What is the ocular sign of torticollis?
Non-commitant strabismus
141
What are some non-ocular signs of torticollis?
Dystonia
Skeletal abnormalities
Deafness in one ear
142
What are some complications of muscular dystrophy?
Severe myopia/glaucoma
Cant open eyes after a sneeze
CPEO (chronic progressive external ophthalmoplegia)
143
How much more likely are cerebral palsy kids to have behavioral problems?
5x more likely
144
What are some ocular characteristics of cerebral palsy?
Hyperopia is more common but if myopia, it is HUGE
Nystagmus
Strabismus
Blepharitis (Treat this aggressively)
145
At what part of the CP scale (cerebral palsy scale) does a patient have a visual perceptual impairment?
3+ = 70% impairment
146
What are 4 clinical tests are for gross motor?
1. Denver
2. NSUCO
3. Standing angels in the snow
Primitive reflexes
147
What 4 clinical tests are for fine motor?
1. Denver
2. VMSP
3. Grooved Pegboard
4. VMI
148
What are engrams?
grouping of neurons in which neurons develop
149
What are important nutrients prenatally? (8)
```
Vitamin B12
Vitamin C
Vitamin D
Zinc
Iron
Folic Acid
Choline
Omega-3 (DHA)
```
150
What information resides in the left hemisphere of the brain?
Grammar/Vocab
Exact calculation
Fact retrevial
Routine processes
151
What information resides in the right hemisphere of the brain?
Visual and auditory
Facial recognition
Spatial concepts
Affect (happy vs depressed)
152
What proportion of the population is right-handed? left-handed?
Right: 70-90%
Left: 8-15%
